"Use of Marijuana in the Haight-Ashbury Subculture" was published in the Journal of Psychedelic Drugs 2, no. 1 (Fall /968): 49-66. Copyright © 1968 by David E. Smith, M.D. Reprinted with minor changes by permission of the publisher and J. Fred E. Shick, M.D.
The authors are grateful to the Indiana University Medical School Research Computation Center for providing computer time under a Public Health Service grant (FR-00162). Completion of this article was supported by a Public Health Service research grant (MH-15436) from the National Institute of Mental Health.

J. Fred E. Shick, M.D.
David E. Smith, M.D.
Frederick H. Meyers, M.D.

Marijuana has been adopted by a significant portion of the youthful subculture as a social drug. Despite marijuana's central importance in helping, us understand current patterns of drug use, only limited information on it is available, especially concerning its relation to the use of other drugs. The present study was feasible because the Haight-Ashbury Medical Clinic provided access to people who widely used marijuana and other drugs.

The Haight-Ashbury Clinic was established in San Francisco in anticipation of the influx of persons into that neighborhood during the summer of 1967; beginning on June 6, 1967, it started to provide free care for acute medical problems as well as for problems related to drug use. By the time this study was made the clinic and its volunteer staff had gained acceptance by the community and was providing care for as many as 200 persons per day.

By September 1967, when our survey was conducted, the well-publicized hippie group had been diluted by a large number of transient youths who were exploring, rather than being committed to, the hip philosophy. To describe the people of the neighborhood at that time as being hippies is to deny the diversity of those who had come to the Haight with differing backgrounds, motivations, expectations, as well as degree of drug experience. Furthermore, the community subsequently changed to include a substantial proportion of compulsive methamphetamine ("speed") users, and the presence of that group was evident at the time of our survey.

The availability of a favorable population and the high regard in which the Haight-Ashbury Clinic was held by that population encouraged us to believe that accurate data could be collected to test our subjective impressions.

Methods

Members of the clinic staff, themselves Haight-Ashbury residents and members of the community, were trained to administer a questionnaire designed to present limited, simple, and self-explanatory choices. The survey included multiple choice questions providing demographic and personal data, present employment, past intidence of psychiatric counseling and hospitalization, drug preferences, and questions detailing the respondents' own use of marijuana, hard liquor, beer and wine, other sedative-hypnotic drugs, oral and intravenous amphetamines, the psychedelic drugs, heroin, cocaine, and opium.

A total of 413 usable questionnaires were completed during the month of September 1967, which sampled both from those who came to the clinic and from other congregation areas ( e.g., Golden Gate Park), and community agencies ( e.g., Huckleberries for Runaways ) within the Haight-Ashbury neighborhood of 20 square blocks. The sample, admittedly a sample of opportunity, is as representative as possible of the Haight-Ashbury's hippie population present at the time. The demographic data agrees well with the findings of other investigators. ( 1 )

Among the community there was a well-known mistrust of the straight society and a history of a lack of cooperation with other investigators who had attempted even less comprehensive surveys. We therefore decided that in addition to protecting the anonymity of the respondent, it would be necessary to have members of the "New Community," as clinic personnel, administer the drug survey in order to obtain adequate and truthful answers concerning drug use. The reputation of the clinic minimized any suspicion that the information collected would be used against the community or any individual. Community leaders were assured that the data would be published only after a reasonable interval. The survey was well received by the community and the refusal rate was less than one percent.

Data from the surveys were transferred onto IBM cards; then several computer programs were written to select and tabulate the information on selected groups from the sample. The statistics are for the most part expressed in percentage form, and an analysis of variance is applied to obtain the standard error and confidence interval for the statistic obtained. Where the percentage statistic of two samples is to be compared and the equality of population means tested, a two-tailed student's T test is applied to the hypothesis of the equality of the means or percentages. In this study the confidence interval expressed is 95 percent or p = .05. Likewise for a difference to be labeled as "significant," a two-tailed test with a p = .05 or less is required unless otherwise stated.'

The characteristics of the population living in the Haight-Ashbury neighborhood have not been constant over any but very brief periods. As the drug-centered community evolved, the relative proportion of individuals who prefer one or another drug or pattern of drug use has changed. At the time of this survey the hippie influence was still influential but waning, and the use of high dose intravenous methamphetamine ( speed) was growing. In order to follow changes in the neighborhood and to test several hypotheses related to sociological aspects of drug use, extensive surveys were carried out at two subsequent times based on random sampling techniques.

The present paper focuses on the patterns of marijuana use and its relationship to the abuse of other drugs. We have briefly characterized the total sample of respondents regardless of their pattern of marijuana use and then discussed areas of difference among various patterns of use.

The Community as Revealed by the Sample

The types of people that this community comprises vary in proportion from one time to another. During the summer and fall of 1967, the time interval that the present study represents, Haight-Ashbury could be described as composed primarily of sons and daughters of the white middle class, who often had some college education and who frequently experimented with various drugs.

Our sample consisted of 413 respondents: 222 males and 191 females. Our analysis substantiates that the population was drawn largely from families of the middle class. The occupation of the head of the household served as an index of socioeconomic class; 51.6 percent of our respondents' fathers had occupations in the professional, managerial, or sales categories, and 44.3 percent of the fathers had some college education. Of the entire sample of 413 respondents, 79.9 percent identified themselves as single and 10.7 percent as married. With regard to race, 86.2 percent of the sample identified themselves as Caucasian; less than 1 percent of the sample was Negro. The sample included 16 American Indians (3.9 percent). The mean age of the respondents was 20.5 ± 1.5 years; 51.8 percent had at least some college education. Some 43 percent of the respondents had not lived with their parents for three years or more.
It is remarkable that about half of the respondents were from states other than California. Only 16.2 percent had been raised in the Bay Area of San Francisco; 34.1 percent had been raised in another large metropolitan area such as New York City, Los Angeles, or Chicago; and 41.4 percent had spent most of their lives in cities of less than 200,000 or in rural areas. One hundred eighty-one (44 percent) were living outside of California before they began to participate in the Haight-Ashbury scene, whereas only 128 (31 percent) were living in the Bay Area.

The use of marijuana was practically universal in this popuration. It was generally used as a social drug, much as the parents of the respondents use alcohol. In answer to the question, "Have you ever used marijuana?" 94.6 percent of the males and 98.4 percent of the females responded affirmatively; 90.8 percent (375) of the total sample had used the drug in Haight-Ashbury, though not necessarily exclusively there, as we shall discuss later. Three hundred eighty-one, or 92.4 percent, had used marijuana within a month prior to the time of the survey, and 87 percent of the total had used LSD or a similar hallucinogenic drug at least once.

It is important to emphasize that this population had a particularly high level of familiarity with various drugs. Some 87 percent had consumed hard liquor, 55 percent had used other drugs of the sedative-hypnotic type, not to mention the 96 percent who had tried marijuana. One fourth of the total sample had tried heroin, though not necessarily intravenously, although only 8 persons were presently abusing that narcotic. About 58 percent had tried smoking opium, or what was thought to be opium, which is an important distinction when discussing "street drugs." Some 87 percent had tried one of the various psychedelics, most frequently LSD. About 35 percent had tried intravenous amphetamine; 75 percent had tried the oral amphetamines; and 36 percent admitted to some personal experience with cocaine. Thus our population differed from other drug using populations in several aspects, and the results of our study should not necessarily be construed as applying to other drug using subcultures.

Levels of Marijuana Use by the Respondents

FREQUENCY OF USE AND PRESENT ACE

It is difficult to speak of the abuse of marijuana in the United States because of the low concentration of active ingredients in the "grass" arriving or grown in the United States at the time of our study and because of its inherent low potential for abuse. Drug abuse may be defined as the use of a drug to the extent that it interferes with one's health, economic, or social functioning. Certainly our questions were not sensitive enough to identify the rare person whose functioning was hindered by his use of marijuana. For the purpose of this analysis we differentiated three groups of marijuana users, namely the occasional user, the regular user, and the habitual user. Our sample consisted of 51 occasional users, 161 regular users, and 177 habitual users of the drug. The occasional user was defined as the individual choosing an answer on the questionnaire indicating use of up to four times in the month preceding the time of the questionnaire. A regular user indicated use of four to thirty times, and a habitual user more than 30 times during the previous month.

Questions regarding the amount of drug used on each occasion were, unfortunately, often regarded as ambiguous by respondents and were not used to determine the level of marijuana use. The loss of data was not great since the variable potency of the product and varying techniques of smoking could not have been evaluated in any case. The use of certain drugs was found to differ in some respects between the sexes, and we believe that their motivations to drug use often were dissimilar. So for the most part the analysis was made of males and females as separate groups and the statistics were then compared. Our sample had a mean age of 20.65 ± .15 years and a range of 9 to 37 years. The ages of the various groups of marijuana users is detailed in Table 1. The mean age of all males was 21.04 ± .2 (range 15 to 34 years), which is significantly older than all females (20.2 .23 [range 9-37 years] ), as illustrated in Table 1. The mean age of the female habitual user of marijuana was significantly younger than either that of her male counterpart (20.99 ± .3) or the females as a whole (20.2 ± .2). This same finding was reflected in the significantly increased number of female habitual users in the 16- to 20year-old age bracket (Table 2).

AGE AT INTRODUCTION TO USE

The entire sample had first tried marijuana at a mean age of 17.07 -± .2 years of age (range 5 to 35 years). The age for first trying the drug tended to vary with the level of marijuana use. That is, the occasional user had first tried marijuana at a mean age of 18,6 ± .7; the regular user at the age of 17.4 ±-- .3; and the habitual user at the age of 16.2 --E. .3. The difference between the age of first trying marijuana and the present age indicated a trend within the groups of male users that is not present among the females. The male occasional user had first tried marijuana on an average of 2.9 years ago, the male regular user 3.4 years ago, and the male habitual user 4.6 years ago. These findings are summarized in Table 3.

The older age group (25 to 30 years), average age of 27.4 years, had the greatest percentage of occasional users, in contrast to the 17 year olds (ages 16 to 20), who had the least number of occasional users. Furthermore, the percentage of habitual users in the 25- to 30year-old age bracket tended to be lower than in the younger age groups (Table 2).

The data in Table 3, analyzed without considering other pertinent data, could lead to the conclusion that the longer one uses marijuana, the greater his use of the drug becomes. But this conclusion is not supported by the data in Table 2, for the older age group had one of the smallest percentages of habitual users, although they had been using the drug for the greatest length of time. In fact, the greatest percent of habitual users and least percentage of occasional users were found among the 16- to 20-year-olds in both the male and female samples.

Our study supports the impression that in the past few years marijuana has been used by increasingly younger persons. In the 25- to 30-year age bracket (mean age 27.4 years) the age of first trying marijuana was about 21, while in the 16- to 20-year-old bracket (mean age 18.8 years) the age was significantly younger, about 16 years. And most of the 10- to 15-year-olds in our sample had tried marijuana within the year, while the 25- to 30-year-olds had tried it on an average of 7 years ago (Table 2). Some 90 to 95 percent of all groups of users agreed they would continue to use the drug, and among the older groups the agreement was unanimous.

CHARACTERISTICS OF THE THREE GROUPS

The habitual user, besides having used marijuana more frequently than the other users, also used greater amounts of the drug more frequently, as one might expect. There was a detectable difference between the amount used each time by the females and the males. There was a tendency (significant at the 90 percent level of confidence) for the females to use less of the drug than the males each time they used it, irrespective of their frequency of use.

Almost 55 percent of the respondents had at one time used or were using marijuana habitually, but it is interesting how often the habitual level of use could be replaced by only occasional use. This was reflected in the eight occasional users (15.7 percent), who had at one time had a peak habitual use of marijuana and the one quarter (23.6 percent) of the regular users, who at one time had used the drug habitually. It is rare to find such decreases in level of use among the users of drugs with more abuse potential, e.g., intravenous methamphetamine; such findings certainly reflect the low abuse potential for the marijuana found circulating in the United States.
The occasional user differed from the regular and habitual user in several important attitudes about his continued use of marijuana. Only three quarters of the occasional users admitted that they still used the drug. Furthermore, significantly fewer of the occasional users ( 77.1 percent) admitted that they planned to continue using the drug, compared with the regular or habitual users, who were almost unanimous ( 95-99 percent) about their intention to continue. Finally, only 13.3 percent of the females and 20.1 percent of the males of the total sample admitted that they had ever worried about their use of marijuana. Only 11 percent of the sample had ever refrained from using any drug because of the dangerous drug or narcotic drug laws.

An analysis of the relationship of the demographic data to the level of marijuana use was remarkable in that no trends were apparent. For instance, there was no correlation between the population of the area in which the user was raised and his level of use. With socioeconomic level, the occupation of the head of the household serving as the index, there was no detectable relationship to the level of marijuana use, although the sample from the working classes was small. Fifty percent of the sample had an educational background of at least some college education. A detailed analysis of the level of schooling achieved and the present level of marijuana use gave no hint of a relationship. It was apparent, however, that there was a particularly large number of people with some graduate education who were also occasional users of marijuana. Otherwise marijuana use appeared to be unrelated to the educational level achieved by members of our population.

THE POSSIBLE HAZARD OF RESIDENCE IN AN ENVIRONMENT OF HIGH USE

We looked particularly at the respondent's time in Haight-Ashbury and his present level of marijuana use. Do those who stay longer have higher levels of use because of increased availability, associations made in the area, and the like? Conclusive evidence is difficult to gain from our questionnaire, since so few had arrived before 1967 ( only 70 respondents, or 17 percent, had come to Haight before 1967 ). We are awaiting more data from the surveys conducted in 1968 to deal conclusively with this question. At this time it can be said, however, that there was no statistically significant difference in the frequency of marijuana use between those who arrived in the summer of 1967 and those who had arrived earlier in that year.

The individual's experience with marijuana was by no means entirely in Haight-Ashbury; his first introduction to the drug was usually outside the community. This is evidenced by a difference of at least two years between the age of his first trying marijuana and the age when he arrived in Haight ( Table 3 ). Many users (73.6 percent) had come to Haight-Ashbury during the first nine months of 1967. In addition, 17.7 percent of the occasional users and 3.1 percent of the regular users had never used marijuana in Haight, and more than half were Haight-Ashbury residents at the time of the study. A significantly lower percentage of the 25- to 30-year-olds had used marijuana in Haight-Ashbury, which perhaps reflects a greater mobility and diversity of experience and acquaintances.

The Use of Marijuana and the Abuse of Other Drugs

ALCOHOL-MARIJUANA CORRELATES .2

The use of the legal ethyl alcohol-containing drugs by this population was particularly interesting, especially when comparing and contrasting the use of marijuana to the use of alcohol. Evidence has been presented that marijuana may be similar in its pharmacologic action to alcohol—that it is a member of the sedative-hypnotic class of drugs. ( 2 ) It was our impression that within this community marijuana was being used as an alcohol substitute. Fifty-two of the total sample (12.8 percent) had never tried hard liquor, yet only about 2 percent ( eight) had never tried marijuana. Only 65.6 percent of the entire group of respondents had used any form of ethanol in Haight-Ashbury, although 90.8 percent had used marijuana there. The average age of the sample was 20.7 years, and almost half were of the legal age to use and purchase alcoholic beverages.

The abuse of hard liquor in this sample was quite small when compared to the abuse of other drugs, notably the psychedelics and intravenous amphetamines. Only about 3 percent of the sample were dependent drinkers of hard liquor and only about one half of them were assuredly abusing the drug in terms of the amount they consumed on each occasion. It is striking that among a population with a very high level of marijuana use and much experience with psychedelic drugs ( where 50 percent habitually used marijuana and 15 percent abused the psychedelic drugs), less than 3 percent abused the ethyl alcohol-containing drugs, hard liquor, beer and wine, in terms of frequency and amount consumed on each occasion.

The males in the survey had first tried hard liquor at about the same age of 13 years, irrespective of their present age, yet there was a difference among the females. The younger females, 16 to 20 years of age, had first tried hard liquor at a significantly earlier age than their 25- to 30-year-old counterparts. The younger females had begun at age 12 to 13, about the same age as all age groups of the males. Perhaps this reflects a change in social attitude toward the use of liquor by females in our society.

But we were concerned with a relationship between the use of marijuana and the use of alcohol and so examined in detail the peak and present levels of the use of both drugs. Our questionnaire distinguished between two types of ethanol use. There were questions concerning the respondents' consumption of hard liquor and their pattern of consumption of beer and wine. Again we determined who in each group was abusing the drug by applying our previously stated definition for abuse. First the respondents' use of hard liquor was compared to their use of marijuana.

Because there was a small sample of hard liquor abusers (number sampled = 12), it was difficult to show any statistical trend about the abusers' use of marijuana. A few isolated trends stood out, however, which began to confirm our impression that in this population a high level of marijuana use was associated with a low level of hard liquor consumption. For instance, among the female occasional users of marijuana, a significantly higher percentage (20 percent) used hard liquor in an abusive pattern than did the regular or habitual users of marijuana. And among the female habitual users of marijuana, their use of hard liquor was quite low. The lowest percentage of hard liquor abuse was among the habitual users of marijuana, although because of the small sample this was not a statistically significant difference.

There was much suggestion in the data that people who had abused hard liquor previously were now at a low level of liquor use but at the same time sustained a high level of marijuana use. Here is a specific example of a sample of males who had abused liquor previously. Of these 26 males, 20 had only minimally consumed hard liquor during the month that this survey was conducted, although their use of marijuana in the same period was almost completely in the regular or habitual use level. All of the 20 had used psychedelic drugs. These 20 who were now at a low level of hard liquor consumption did use the drug in excessive quantities on the rare occasions when they consumed hard liquor; that is, two thirds used it to get drunk, sick, or pass out on these occasions. Three quarters of these former abusers of hard liquor stated that they did not plan to continue drinking hard liquor, all planned to continue using marijuana, and practically all attributed the change in their hard liquor consumption to having taken marijuana and/or LSD.

Of the total sample, 309 had decreased or stopped their consumption of hard liquor, 79 percent attributed this change to their having taken marijuana and/or LSD. Again, 90 percent were regular or habitual users of marijuana, among a community that condones marijuana use much as the middle class condones the consumption of alcohol. Certainly it is dangerous to suggest a cause and effect relationship between taking marijuana and decreasing alcohol consumption; to underscore this point we would add that when asked about their preferred drug or drug of choice, so to speak, 61.8 percent of these persons preferred the psychedelics and not marijuana as first choice; marijuana as a second choice drug, however, was quite commonly preferred (56.6 percent ).

MARIJUANA-LSD CORRELATES

There was a high degree of association in our sample between the use of psychedelics and the use of marijuana. And it is our impression, supported by statistics from this survey and in agreement with the impressions of others, that in this community in the summer and fall of 1967 the use of LSD and the use of marijuana were practically inseparable. One must remember that in the summer of 1967 this community consisted of people who used primarily the psychedelics and marijuana. In fact the "hippie ethic" and the "New Community" had part of its basis in the use of the psychedelics, and only secondarily used marijuana.

Unwilling to accept established conceptions about drugs, this population has experimented a great deal with a variety of drugs. And as we began to examine the abusers of each drug included in our survey, it became clear that the abuse of one drug was often associated with the abuse of another drug, often within the same time period. We were able to distinguish an abuser group—a group of persons who only experimented with various drugs—as well as a group who used drugs regularly but infrequently abused them. This latter group of users used primarily the psychedelics and marijuana.

There were the experimenters, only 27.4 percent of the total sample, who have made no significant use of any of the illegal drugs but only 14.5 percent of the sample who never have had more than an occasional use of any illegal drug except marijuana. Then there were the persons who regularly used marijuana and one or another of the psychedelics but had no abusive pattern of use of any drug ( amphetamines, heroin, liquor, psychedelics); these persons made up one third of the community. Finally, there were the drug abusers (19.4 percent of the sample), most commonly of the psychedelics, whose use of other drugs was usually on the abusive level. This we call the abuser group. Among the regular marijuana–LSD users only 9 percent had abused another drug during the same period, while among the abuser group almost 32 percent had abused another drug.

The drug most commonly used in Haight-Ashbury, aside from the almost universal use of marijuana, was the class of psychedelics. And these were the drugs most commonly abused. The next most commonly abused drugs were the intravenous amphetamines, commonly methamphetamine. Of the total sample, 84 percent had tried'one of the psychedelics at least once (usually LSD) and two thirds had used the psychedelic drugs at least once during the month of September 1967. LSD was the drug most commonly abused. Of those who had abused any illegal drug except marijuana (the abuser group) 74 percent had abused LSD or another of the psychedelics. By contrast only 9.9 percent of this group abused heroin. A significant 44.4 percent of the sample of abusers abused only the psychedelics; these persons had an associated habitual use (86 percent) of marijuana. Of the persons who used only the psychedelics but did not abuse them, 75 percent abused no other drug, although marijuana was used by one half habitually.

The habitual use of marijuana was significantly more frequently associated with the abuse of the psychedelics than with the abuse of any other drug (Table 4); 85 percent of the psychedelic abusers also used marijuana habitually, and this is significantly higher (p < .05) ["<" means "less than"] than the frequency of habitual marijuana use in any other abuser group. By contrast, among the regular users of the psychedelics (i.e., those who used the psychedelics and marijuana almost exclusively) only 52 percent used marijuana habitually. The abuse of the intravenous amphetamines was negligible in this group of regular LSD users; only 11 of 175 had abused the intravenous amphetamines. But among abusers of the psychedelics, 23.3 percent also abused amphetamine intravenously in the same period as their abuse of LSD.

It is interesting to compare the age of the abusers and regular users of the psychedelics when first hying marijuana and hard liquor. The mean age of the psychedelic abuser ( 19.8 ± 0.4 years) was significantly younger than the regular LSD—marijuana user. Likewise, among psychedelic abusers the mean age of first trying marijuana was younger ( 15.2 ± 0.4 years) than among the LSD-marijuana ( regular LSD users) user group ( 16.8 ± 0.2 years). But the difference between the mean ages of first trying marijuana and the present ages of the respondents differed by only one year. The mean age for first trying hard liquor was significantly younger among the abuser group than among the regular LSD—marijuana user group. We do not believe that the age for first trying marijuana and the level of use of drugs is causally, related, but the significantly younger age for hying hard liquor and marijuana among abusers may reflect early conditions that predispose one to abuse drugs. Certainly the high level of abuse of one drug associated with the abuse of other drugs supports the multiple drug abuse theory, explained in the discussion.

MARIJUANA-AMPHETAMINE CORRELATES

Of the total sample of 413 respondents, 34.1 percent had tried using amphetamines by intravenous administration at least once. Of these 21.3 percent ( 7.3 percent of the total sample) were abusing the drug at the time of our study. The intravenous amphetamines were the second most commonly abused drug within our sample. Among the various levels of marijuana use ( occasional, regular, habitual ) there were no significant differences between the percentages of intravenous amphetamine abusers in each group: a range of from five percent of the occasional users to 11 percent of the habitual marijuana users. Among the habitual users of marijuana, however, there was a significantly greater frequency (p < .10) of experimental and periodic use of intravenous amphetamine than in the occasional or regular marijuana use categories. This simply reflected a greater frequency of drug use among those who had extensive acquaintance with drugs and who frequently experimented with various drugs and means of administration.

Apparently the level of intravenous amphetamine use had no relationship to the level of marijuana use, for the perecentage distribution of the various levels of marijuana use was statistically the same whether among experimental users, periodic users, or abusers of the intravenous amphetamines (Table 5). From 8 to 13 percent were occasional users of marijuana; 22 to 34 percent were regular users of marijuana; and 56 to 63 percent were habitual users of marijuana. The habitual level of marijuana use was the most frequent within the various levels of intravenous amphetamine use and abuse, as it was among the total sample of 413. It is true that habitual marijuana use was significantly more frequent among respondents who were using any intravenous amphetamines at all than among the total sample of 413. But other levels of marijuana use, namely occasional and regular use, were no more frequent among users or abusers of intravenous amphetamines than among the sample as a whole.

If we consider only the abusers of the various drugs we find that the frequency of habitual marijuana use was significantly greater (p < .05) among the abusers of the psychedelics than among any other abuser group. Although the frequency of habitual marijuana use was significantly greater among the abusers of the intravenous amphetamines than among the general population of Haight, it cannot be considered significantly greater than the other abuser groups, namely oral amphetamines or heroin, because of the small sample from these groups.

Originally it was our impression that the frequency of marijuana use among abusers of the intravenous amphetamines would be quite high because of observations that marijuana was being used to aid the person who was "coming down" from intravenous amphetamine intoxication, much as a sedative would be used. This practice may account for the significantly greater frequency of habitual marijuana use among the intravenous amphetamine abusers than among the sample as a whole.

It is, however, difficult to account for the high association between habitual marijuana use and abuse of the psychedelics, except to explain that these were the most "socially acceptable" drugs within this subculture; their association may simply reflect the social preference. It may also be true that marijuana was used to modulate the psychedelic experience either as a "downer" (a sedative) or in an attempt to heighten the experience.

Summary of Drug Preference

Certain.questions in the survey concerned a respondent's drug preferences. His drug of choice was that drug that he considered best to fulfill the goals that he associated with taking drugs. A unique feature of our respondents in this population was their preference for psychedelics; 46.8 percent of the respondents listed LSD as their first choice, and 25.5 percent listed marijuana first. Although 8 percent of the sample were abusing intravenous amphetamines, only 3 percent listed that drug as first choice. The preference for LSD existed among practically all groups of users and abusers within this community. Marijuana was listed by 53.9 percent of the respondents as second choice, and LSD was listed second by 19.4 percent.

Discussion

A few concepts and definitions must be reviewed before discussing the problems of multiple drug use and the inverse or direct relation between the use of one drug and another. Why, for example, was the inverse relationship between hard liquor consumption and marijuana use just described in this population not repeated when the consumption of beer and wine by the marijuana users was considered?

CLASSIFICATION OF DRUGS SUBJECT TO MISUSE

Psychoactive drugs may be classified in several groups according to their mode of action. We have discussed hard liquor, which is a sedative-hypnotic. Other members of this general classification include the other ethanol-containing drugs (in our survey beer and wine), the barbiturates, and drugs formerly termed "minor tranquilizers" but now known to be sedatives, such as meprobamate ( Miltown), chlordiazepoxide (Librium), and diazepam ( Valium). Furthermore, there is evidence to support the classification of marijuana as a sedative drug. (2) A second group of drugs is the opiate derivatives: heroin, morphine, crude opium, and narcotic synthetics. It is generally agreed that marijuana is not a member of this class of drugs. A third group of drugs are selective central nervous system stimulants, conveniently termed the psychedelic or hallucinogenic drugs, such as LSD-25, STP (DOM), MDA, mescaline, and psylocybin. Marijuana is said by some to be a "mild hallucinogen" and was compared in some studies to peyote or mescaline in its effects (3), which implies its inclusion in this class of drugs. It must be remembered that the occurrence of hallucinations, or what has been termed pseudo-hallucinations (Li) with a particular drug, does not automatically place it in the class of psychedelic drugs. Nitrous oxide, ethanol, and amphetamine may produce hallucinations at certain stages of intoxication or withdrawal. The authors of this article prefer its classification as a sedative and have assembled evidence in support of this hypothesis. (2) A fourth group of drugs are the general stimulants of the central nervous system—drugs of the amphetamine type, including oral and intravenous amphetamine ("speed") and nicotine and caffeine. In passing we should note how similar are the psychedelic drugs and the amphetamines in pharmacologic action and chemical structure (Figure 1).

PATTERNS OF DRUG USE

It is of central importance to distinguish between the use and the abuse of a particular drug, whether one talks about alcohol, marijuana, or the amphetamines. Any drug may be used or it may be abused. For example, many people drink alcohol but do not become alcoholics. How then do we define abuse? Abuse may be defined as the use of a drug to the point where it seriously interferes with the user's health, social or economic functioning, but what factors are operating in relation to the person who is using or abusing drugs? Both the best and the worst consequences of drug use tend to be attributed to the drug itself. It is important to realize, however, that there are other factors operating besides the obvious pharmacologic effects. There are three groups of factors that influence drug use: the drug factors (i.e., pharmacologic tolerance, physical dependence, abstinence syndrome, behavioral toxicity, and metabolism), the individual factors, and the group factors. These have been discussed elsewhere by one of the authors. (7) These factors interrelate to determine the individual's particular pattern of drug use. The various ways in which persons use drugs may be most easily considered by discussing four patterns of drug use: the experimental use, the social use, the ritual use, and the compulsive use. The elective experimental or episodic use of drugs implies primarily the use of drugs infrequently, though the person may perhaps use an astounding variety of drugs experimentally. The social pattern of use is the occasional or periodic use of drugs in a social setting, where attaining a state of intoxication is of secondary importance to the facilitation of social interaction and the alleviation of the social anxiety by the drug. The paradigm here may be the use of alcohol by the middle class as a social drug. The ritual pattern of use, somewhat less familiar but quite important when considering drug-using subcultures, is the use of a drug as a part (sacrament, perhaps) of a ritual, or more generally drug use to achieve previously defined goals, often of a philosophic or psychotherapeutic type, which may or may not be realistic. The use of peyote by the Native American Church is an example of this pattern of use. The compulsive pattern includes the need to continue the use of the drug even in the face of deterioration of the user's functioning, as well as the tendency not to return to lower levels of use or to lower doses but usually to increase the dose, regardless of pharmacologic tolerance. The drug abuser (whether the alcoholic, the heroin abuser, the oral, sedative abuser, or the like) represents this compulsive pattern of drug use.

MULTIPLE DRUG ABUSE

There are several theories about drug abuse and the drug abuser, but a particularly useful one, and one that is supported by our data from this drug-centered community, is the multiple drug abuse theory. The person who has an abusive pattern of use of one drug is more likely to abuse another drug, either concomitantly or when the first drug becomes less available. This theory implies that there are people who are prone to abuse ( or compulsively use) any drug, although they may prefer one drug to another for its effect or lack of side effects. It is not meant to imply that all abusers exhibit a particular personality or type of psychopathology. Furthermore, such a theory should not be applied to the social or ritual use of drugs, e.g., marijuana by the youthful subculture or LSD by an indoctrinated hippie, nor should its emphasis on individual susceptibility obscure pertinent group factors.

The multiple drug abuse theory assumes that abuse of drugs by an individual may extend beyond a single class of drugs, for instance the amphetamines, into another group with different properties such as alcohol, a sedative drug. This type of abuse—abuse of drugs in differing classes—is known as horizontal abuse. An example would be the amphetamine abuser who also abuses the psychedelic drugs or the narcotics, such as heroin. A different pattern of abuse may be called vertical abuse—the abuse of different drugs within the same drug classification. An example of this form of abuse is the alcoholic who also abuses another sedative, for instance chlordiazepoxide (Librium). The use of drugs within the same class may lead to an additive effect of the two drugs being used together in the same time period; that is, the effect of one drug adds its effect to the effect of the other drug. This result is twice that of other drugs used alone in the same dosage.

INTERCHANGEABLE USE OF MARIJUANA AND ALCOHOL

Now these concepts may be applied to our study, in particular to the use of beer, wine, and marijuana by the population that we studied. We noted that our data tended to support our impression that marijuana was being used as an alcohol substitute within this subculture, and that the consumption of alcohol had declined for many of the respondents, although their use of marijuana was quite high. To suggest any cause for such a change or the exact nature of that cause would be highly speculative, but we should mention that 80 to 90 percent of a given sample attributed their decrease in alcohol consumption to their having taken marijuana and/or LSD, and agreed that their use of marijuana and LSD came before the decline in their use of alcohol. The role LSD has played in such a change is difficult to evaluate, but certainly a greater percentage prefer LSD to marijuana.

Nevertheless, if we look at the group whose consumption of hard liquor had decreased or stopped, we find that although their use of beer and wine had also decreased for the most part, significantly fewer of these persons had discontinued their consumption of beer and wine and more planned to continue their consumption of these beverages in the future. Only 23 percent of this sample of persons whose consumption of hard liquor has decreased or stopped planned to continue drinking hard liquor; but 58 percent planned to continue drinking beer and wine. Objective evidence, however, indicates that their consumption of hard liquor was usually at a lower level of use.

There were 31 persons who had abused ethanol in some form ( hard liquor or beer and wine) but who were presently consuming minimal amounts of alcohol; 9 of them had stopped drinking hard liquor altogether. All were habitual users of marijuana and all had continued drinking beer and wine but in nonabusive amounts.

Why do not attitudes and practices toward beer and wine follow the decreased consumption of hard liquor among the marijuana users in this population? There are many possible explanations and probably not any single explanation will suffice. But we have on several occasions talked to members of this community who spoke of their concurrent use of marijuana and wine. A group would smoke several "joints" of marijuana and then consume a bottle of wine. They insisted that this practice led to becoming much more "stoned"; the experience of marijuana and wine together was said to be better than the use of either drug alone. The occurrence of such a practice would explain the statistics; moreover, it would be an example of the additive effect of two drugs being used together. It is known that alcoholics will try to get sedative drugs to decrease their consumption of alcohol; this is certainly the practice in the medical treatment of withdrawal from alcohol to substitute one safer, longer acting sedative drug for ethanol, a shorter acting sedative with a low degree of safety. If one considers marijuana a sedative drug like ethanol or the barbiturates, then this is an example of vertical abuse. Heroin abusers at times will abuse a barbiturate in order to decrease their dependence on heroin—an example of horizontal abuse; the reported contamination of LSD with methamphetamine to increase the subjective effects aims at a similar result.8

MARIJUANA USE AND THE SEQUENTIAL THEORY OF DRUG ABUSE

The habitual use of marijuana is often associated with the abuse of other drugs not in the same pharmacologic class. The habitual use of marijuana is frequently associated with the use of the psychedelic drugs, for example, which is a case of vertical abuse if marijuana is considered to be a psychedelic or horizontal abuse if it is considered a sedative. In any event there were many examples of high levels of marijuana use associated with high levels of use or abuse of other drugs within this community. Marijuana is involved in both horizontal and vertical use within this community as a social drug, a spree drug, and a depressant to antagonize stimulant drugs.

The sequential theory of drug abuse, that the use of marijuana will lead to the abuse of heroin in particular, has been the subject of much debate. Most authorities now agree that there is little basis in fact for such a statement. (3) Our data strongly supports its refutation.

Only 8 of the total sample of 413 respondents were heroin abusers. The percentage of heroin abusers presently using marijuana habitually was significantly lower than the high percentage of habitual marijuana use among the abusers of the psychedelics, and tended to be lower than the frequency of habitual marijuana use among any other abuser group. Only half the heroin abusers habitually used marijuana, yet 85 percent of the abusers of the psychedelics habitually used it. The levels of marijuana use among the abusers of the various drugs are shown in Table 4.

This survey suggests a surprisingly high incidence of experience with opium among the respondents. For reasons mentioned below, we believe that our questions did not provide a valid measure of the amount of opium actually used. Of our total sample, 58.3 percent admitted to having tried opium at some time, and 36.3 percent stated that they had used opium while in the Haight-Ashbury neighborhood. However, more detailed interviews with residents and dealers suggest that many of their answers were based on the very dubious assumption that they had used "opium-cured grass" at one time or another. The small amount of opium brought into the community in the past was used in small amounts and in a group setting very much as marijuana was used.

As alluded to above and as explained in other papers ( 6) the selling of drugs on the street in this community involves what might be termed a "Madison Avenue approach." Drugs are being sold under constantly changing guises, fantastic claims are made about each drug, and the user has a preconception about the expected effect of a particular drug sold to him, even before he has experienced it. Many drugs are billed as containing one ingredient when in fact they contain something else.

There have been actual attempts at "curing" marijuana in solutions of such drugs as DMT or cocaine, but such curings are hardly frequent enough to account for the often-heard patter of the seller about "opium, DMT, or cocaine-cured grass." The different effects one may experience with marijuana purchased in Haight is more rationally explained by attributing them to the amount of active ingredient, rather than attributing them to a contaminant in the marijuana, as the community often does. It is known that attempts at curing marijuana in sugar have been successful; hence stories of DMT or opium curing should not be dismissed as mere fiction.

1 See Jerome C. R. Li, Statistical Inference (Ann Arbor, Mich.: Edwards Brothers, Inc., 1966).

2 In this paper the terms alcohol, ethyl alcohol, and ethanol are used interchangeably.

3 Illegal LSD is sometimes mixed with methamphetamine to decrease the amount of LSD needed to produce an effect.

References

1. DAVIS, F., and MUNOZ, L. 1968. Heads and freaks: patterns and meanings of drug use among hippies. Journal of Health and Social Behavior 9: 156-64.
2. MEYERS, F. H. 1968. Pharmacologic effects of marijuana. Journal of Psychedelic Drugs 2, no. 2: 30-36. See above pp. 35-39.
3. McGLoTHLIN, W. H. 1964. Hallucinogenic drugs: a perspective with special reference to peyote and cannabis. Santa Monica, Calif.: The RAND Corporation.
4. SMITH, D. E. 1967. LSD: An Historical Perspective. Journal of Psychedelic Drugs 1, no. 1: 1-7.
5. Smrru, D. E., and ROSE, A. J. 1967. "LSD": Its use, abuse, and suggested treatment. Journal of Psychedelic Drugs 1: 117-23.
6. MEYERS, F. H.; ROSE, A. J.; and SMITH, D. E. 1968. Incidents involving the Haight-Ashbury population and some uncommonly used drugs. Journal of Psychedelic Drugs 1, no. 2: 136-46.
7. MEYERS, F. H.; JAWETZ, E.; and GOLDFIEN, A. 1968. Review of Medical Pharmacology. Los Altos, Calif.: Lange Medical Publications.